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Cardiovascular Report - When a Leaky Mitral Valve Can Be Repaired in a Less Invasive Way
Cardiovascular Report Fall 2012
When a Leaky Mitral Valve Can Be Repaired in a Less Invasive Way
Date: October 30, 2012
Kaushik Mandal says the key to successful minimally invasive cardiac surgery is offering it to the right patient.
Paul Leitner-Wise, a 50-year-old industrial designer from Alexandria, Va., always knew he had a heart murmur. An echocardiogram 10 years ago confirmed the diagnosis of mitral valve prolapse. “However, my doctor told me it was nothing to worry about,” he says, “and since I had no symptoms, I wasn’t concerned.”
But during an evaluation for surgery to repair a bilateral inguinal hernia last spring, he had an echocardiogram and was told to see a cardiac surgeon immediately. “I learned that the mitral valve leakage had gotten much worse and that my heart was enlarged and beginning to fail. It was quite an eye-opener,” he says.
A local cardiac surgeon said Leitner-Wise was eligible for either a repair or replacement of the valve, and that the surgery would be performed as an open operation. “I didn’t want my chest cracked,” says Leitner-Wise. “So I began to look for a cardiac surgeon who could repair the valve in a less-invasive way within a reasonable time period.”
He came to Johns Hopkins and met with cardiac surgeon Kaushik Mandal, who has performed over 100 mitral valve repairs—using mostly minimally invasive techniques. Leitner-Wise’s valve needed a P2 resection and ring annuloplasty for restoring competency. The procedure is technically more demanding, but the patient benefits by having less pain and a much faster postoperative recovery.
“A segment of Mr. Leitner-Wise’s leaflet was flopping backward into his left atrium,” says Mandal. “To repair the valve, we made a 5-centimeter cut on the right side of his chest and removed a small segment of the leaflet. We then made the valve more stable by placing a fabric-coated rubber ring around it.”
Mandal says that by preserving the patient’s native valve, he would have less risk of infection and would not need to take anticoagulants.
Eligibility depends on the patient’s size and medical condition. Patients who are very overweight, or have sleep apnea, pulmonary hypertension, or vascular or peripheral arterial disease would not be good candidates, he says.
Compared to the advice Leitner-Wise received more than a decade ago that having mitral valve prolapse was not a major concern, the thinking today, according to Mandal, is that early repair is vital. He says valve leakage can go from mild to severe in a short period of time, and once the heart starts to fail, the results of repair are not that good.
Following his surgery, Leitner-Wise spent five days in the hospital before going home. From now on, he will receive an echocardiogram each year.
“If it hadn’t been for my hernia,” he says, “I wouldn’t have learned that my heart was failing from my leaky mitral valve. I’m glad I found out when I did so the problem could be corrected, and I’m grateful that it could be done in a minimally invasive way.”